Phacoemulsification has come to be a technique of choice for the removal of damaged or diseased lenses from the eye. Commonly, such surgery is called for when a patient develops cataracts, a condition in which a portion of the eye lens becomes hard and opaque. Unless the damaged lens is removed and replaced with a properly selected artificial lens, blindness or severely impaired vision will result.
Phacoemulsification is the use of ultrasonic energy to emulsify the damaged lens and aspirate the resulting lens particles from the eye. One of the most significant advantages of the use of phacoemulsification is that the apparatus itself is small and can fit through a relatively small incision, resulting in less fluid leakage from the eye capsule and shorter patient recovery times. It is desirable to limit the amount of ultrasonic energy used as much as possible in order to minimize the risk of damage to eye tissue. Often, the lens nucleus (the hardest portion of the lens) is chopped or split into smaller pieces prior to or during phacoemulsification. Smaller pieces require less energy to emulsify, and this shortens the time during which ultrasonic energy is actually being created by the phacoemulsification apparatus.
Known fractionating techniques include making incisions into the lens and, thereafter, prying the incisions open to split the lens into halves or quarters. As an example, U.S. Pat. No. 5,147,368 (Brown) teaches and describes a nucleus splitter in the form of a forceps, the jaws of which are intended to be inserted into a groove or incision already cut in the nucleus. When the handle of the nucleus splitter is squeezed, the jaws are forced apart thereby prying apart the groove or incision or splitting or cracking the nucleus into fragments.
U.S. Pat. No. 4,428,748 (Peyman, et al.) teaches and describes a combined ultrasonic emulsifier and mechanical cutter for surgery. This device includes the typical components of a phacoemulsification apparatus, namely, an ultrasonically vibrated hollow needle and one or more aspiration ports through which the emulsified lens particles are drawn and evacuated from the eye capsule. Peyman, et al. also includes a rotary mechanical cutter formed in the tip of the apparatus to be used for cutting nuclear tissue.
U.S. Pat. No. 6,592,541 (Kurwa) teaches and describes an opthamological surgical instrument device and method of use in which the tip of a phacoemulsification needle is formed with a cutting edge which can be inserted into the nucleus for the purpose of making an incision. As described by the inventor, a nucleus cracker or pre-chopper is then required to split the nucleus after which the phacoemulsification instrument is reinserted and used to emulsify and aspirate the lens fragments.
As used throughout, the term “pre-chopping” refers to the opthalmological surgical technique of making a plunge cut directly downward into the nucleus in order to form a channel or incision. The term “chopping” refers to the technique of forming grooves or incisions in the eye by drawing an instrument having a cutting edge across the lens.
Examples of known prior art choppers are illustrated in the accompanying drawings. One such chopper identified as Model No. AE-2515 sold by ASICO LLC of Westmont, Ill. is shown in FIGS. 1, 2 and 3 and consists of an elongated shaft having a blade portion formed at the end of the shaft and extending at an angle to the shaft. The cutting edge of the blade portion faces toward the handle of the instrument, meaning an incision is made when the instrument is placed on the nucleus and then drawn across the nucleus. This instrument is available in both 90 degree and 60 degree angled cutting edges.
Another prior art chopper is identified as Model No. AE-2523 manufactured by ASICO LLC and consists of an elongated shaft with a hook-like projection extending at an angle to the shaft. As with the Model AE-2515, a cutting edge is formed on the interior surface of the hook and cutting occurs when the chopper is drawn across the nucleus. The hook shape allows the Model AE-2523 to be used to manipulate the lens within the capsule. Thus, once a first incision is made, the lens may be rotated 90 degrees and a second incision made to divide the lens into four quadrants.
FIGS. 6, 7 and 8 show a prior art pre-chopper identified as Model No. AE-4287, sold by ASICO LLC. As described in more detailed herein, the Model AE-4287 has a spring steel blade assembly positioned within a tube with the end of the blade assembly forming a pair of blade leaves. The handle of the instrument is manufactured with a linkage which, in its normal position, is spread apart, a position in which the blade leaves are separated. When the handle is squeezed, the blade assembly is drawn into the blade tube and the two leaves are forced together to form a single solid blade. This blade has an upper straight surface which is sharpened and a lower curved surface which is blunt. In use, the AE4287 pre-chopper is inserted into the eye capsule and is rotated to bring the straight sharpened edge into contact with the upper surface of the lens. A plunge cut is then made to form a partial incision. The instrument is then turned 180 degrees to bring the blunt portion of the blade assembly into contact with the lens, within the incision. Thereafter, when the handle linkage is released, the leaves separate exerting a splitting or cracking force on the lens along the incision made by the pre-chopper. After several such incisions are made, and the lens is fractionated, the lens fractions may be emulsified and removed by phacoemulsification.
An instrument combining the features of both a chopper and a splitter is described in my co-pending application Ser. No. 11/069,774, filed Mar. 1, 2005, which is incorporated herein and is depicted in FIGS. 6-18. This instrument is a pair of tips that can be separated to act as a splitter and, when drawn together, form a single, vertical cutting edge used by drawing the instrument across the nucleus to incise it.